Oromandibular dystonia is thought to originate from a dysregulation of centrally mediated movement, whereby repetitive or sustained spasms of the masticatory, facial, or lingual muscles result in involuntary, and possibly painful jaw movement. Here we present 2 unique cases of oromandibular dystonia referred as temporomandibular joint disorders. Keywords Temporomandibular joint disorders; Meige syndrome; oromandibular dystonia. Case reports Case 1 A 78-year-old white woman referred by her oral

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... urgeon for evaluation of masticatory dysfunction presented on a mobility scooter with slurred speech and chief complaint of "jaw spasm, difficulty chewing, and change in bite" ongoing for 4 years. Dental history included mandibular left quadrant implant placement 4 years earlier, resulting in parasthesia of her lower lip secondary to surgical injury to the inferior alveolar nerve. She was subsequently treated by an oral surgeon who removed these implants 1 month after placement; this did not alter the sensory deficit. A year later, she began to experience facial spasms with mandibular deviation to the right. She had several repeated occlusal adjustments, but lost 2 teeth due to a fracture in the upper right quadrant reported as progressively worsening over the 4 years. She had been treated with low dose botulinum toxin A injection by her neurologist to differentially weaken the facial muscles on the left side. Her medical history included seasonal allergies, asthma, moderate acid reflux, osteoporosis, and occasional vaso-vagal episodes since 2000. Her neurologic history included herniated disk C5-6 with radicular left arm pain, irritable bladder, past polio as a child resulting in left leg degeneration, and peripheral neuropathy with coldness and tingling in both feet. This paper is available online at http://www.grandrounds-e-med.com. In the event of a change in the URL address, please use the DOI provided to locate the paper.